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9 VALLEY ST - BUILDING INSPECTION Dda n. Loomad M�o n, ' 'a-1�bW Ya�� Now sat Uq //e W PMNIy board In ;r Iwo Ana SINLOW PEIMMT APPLICATION POP: Permit to (Ckcb whMwm apply) Roof, Rd roof. wow Swft Caflamw Doak. Shad, Pool. RMAWRapyas. ORM. PLEASE PILL OUT LEOMILY•COMPLETELY TO AVOID DELAYS W PROCESSWGI TO THE INSPECTOR OF SlN' NGI& The W da SOW hW* #WW for a pe mit to build awwft to 0010110wirp OwrWs Name - Ad*m a Phone 9 Oal/Py ST e, Y 3 Amhk@ is Name Address a Phorw j MoChanica Name Address A Phone j NO it a■PAPM it NOW MAU"a oillaro9 r a aralrlo,for how wmw MAW vm home aoidana r rw7 EWAW eat 460 - cw umm o NIA awe uo r SowMe of AX*W SIGNED UNDER TM PENALTY oP PERJURY DESCRIPTION OF WWII(TO U DONE tC--NO GLi /oL ' tcH J j OAf__ MAIL PERMIT TO: 91 UIJLE�� rfj L�.y ©�� No. 6F D APPLICATION FOR PIMA I TO 2N Gv. ,GCO„is Si�I/�i LAGATION !/ PEFMT GRANTED A= OF 6UILDINM l CITY OF SALEM A s MASSACNUSETTS PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET. 3RD FLOOR SALEM. MASSACHuSETTS 01970 3TANLEV J. UEOVICZ, JR. TELEPHONE: 978-743-9393 EXT. 380 MAYOR FAX: 978-740-9846 HOMEOWNER LICENSE EXEMPTION Please Print. Date . 1l Job Location Q V �e S So, 1 e VIA q Home Owner Addm a. P Home Owner Telephone Present Marlin Addteea,. The current ex " 'empdon of"Homeowner>!�"was.extended to include ownw occupied dwellings Of two Units or less and to allow such homeo to engage an individual for hire who does not possess a license,provided that the Owneras supervisor. DEF04 TION OF HOMEOWNER 4a ' Person(s)who owns a parcel of brad 0n which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling, attached or detached structures accessory to such use and/or faun Structures. A than one home in a two yearcons person who homeowner. Such more "homeowner"shall submit th Building OfficialOn a�fom°meptable Such Official, that he/she be responsible for all such work acceptable to the Building Permit performed under the Building The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable by-laws and regulations. The undersigned"homeowner"certifies that he/she understands the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE r APPROVAL OF BUILDING INSPECTOR v See other side for state code HOMEOWNERS.E�TION performing work for which a Building Permit is The Code states that. "Any Homeowner required shall be exempt from the provisions of this section(Section 109.1.1 —Licensing Supervisors);Provided that a Homeowner engages a person(s) for hire to of Construction do such work. and that such Homeowner shall act as Supervisor. exemption are unaware that they are assuming the Many Homeowners who use this m Appendix Q Rules and Regulations for Licensing responsibilities of a Supervisor(see Appenddrx lack of awareness often results in serious Construction Supervisors,Section 2.15). This In this case your Particularly when the Homeowner hires unlicensed persons a licensed blems. it would pro the unlicensed personas r Beard cannot proceed against s� is ultimately responsible. Supervisor. The Homeowner acting as "If,- To ensure that the Homeowner is fully aware of his/her re the Homeowner certify that e Hom,many communities require. as a part of the Permit Application, responsibilities ft of a Supervisor. on the last page of this issue is a helshe and nused towru you may can to amend and adopt such a form certificurrently our community form/certification for use in Your 9 CITY OF .SALEM, MASSACHUSETTS Is PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RD FLOOR SALEM, MASSACHUSETTS 01970 STANLEY J. USOVIC2, JR. TELEPHONE: 978-745-9595 EXT. 380 MAYOR FAX: 978-740-9846 Salem Buildin¢ Department Debris Disposal Form In accordance with the provisions of MGL c40 S 54, a condition of your Building Permit is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL Chapter III, S 150 A. The debris will be disposed of in: Okbe)A t1J p 4 00 S L (Location of Facility)_ � � e Le A Signature of Applicant Date